Rotator Cuff Pain: Signs, Causes, and When to Get Checked

Maybe it started as a twinge when you reached for the top shelf. Now it aches when you put on a coat, and lying on that side wakes you up. You keep waiting for it to fade. Rotator cuff pain often builds slowly like this, which makes it easy to ignore for too long.

What is rotator cuff pain?

Rotator cuff pain is pain from the group of muscles and tendons that hold your upper arm in the shoulder socket. The rotator cuff helps you lift, reach, and rotate your arm. When its tendons get irritated or torn, everyday movements start to hurt.

Problems range from irritated tendons (tendinitis) to partial or full tears. According to AAOS², a partial tear leaves the tendon attached but thinner than normal. A full-thickness tear separates part or all of the tendon from the bone.

Rotator cuff trouble is common. Cleveland Clinic³ reports that more than 2 million Americans have some type of rotator cuff problem each year. Some people even have tears without any symptoms³. For the bigger picture, see our guide to shoulder pain.

What are the signs of rotator cuff pain?

The classic sign is a dull, deep ache in the shoulder that's worse at night or with reaching. According to Mayo Clinic¹, rotator cuff pain may:

• Feel like a dull ache deep in the shoulder
• Disturb your sleep, especially when you lie on that side
• Make it hard to comb your hair or reach behind your back
• Come with weakness in the arm

AAOS² adds pain when you lift or lower your arm, and weakness when you lift or rotate it. Some people also notice a crackling feeling with certain movements. Cleveland Clinic³ lists popping or clicking, and trouble lifting objects.

Night pain is one of the most common complaints. Our guide to shoulder pain when sleeping covers positions that may ease it.

Is it irritation or a tear?

You can't tell for sure on your own, but the pattern offers clues. How the pain started matters most.

Shoulder impingement can also feel similar. It happens when tissues at the top of the shoulder get pinched as you raise your arm. Learn more about shoulder impingement and shoulder pain when lifting your arm.

An exam helps sort these out. Your doctor checks how your shoulder moves and where it's weak or tender.

What causes rotator cuff pain?

Most rotator cuff problems come from gradual wear on the tendon over time. According to Mayo Clinic¹, repeated overhead activity or heavy lifting over long periods can irritate or damage the tendon. A single fall or accident can also cause an injury.

AAOS² explains that blood supply to the tendons decreases with age. That makes it harder for the tendon to repair small damage. Over years, the tendon can wear thin and tear.

Who is more likely to get it

• Adults over 40. Tears are most common after age 50¹. AAOS links most tears to normal wear with aging².
• People in overhead jobs. Painters, carpenters, and mechanics raise their arms again and again^1,3.
• Athletes. Baseball, tennis, rowing, and weightlifting stress the shoulder^1,2. See shoulder pain from lifting weights.
• People with a family history. Rotator cuff injuries appear to run in some families¹.
• Smokers. Cleveland Clinic³ lists smoking and poor posture as risk factors.

Your dominant arm is the one most often affected. AAOS² notes that a wear-related tear in one shoulder raises the odds of one in the other. If your work keeps your arms overhead, see our care for physical jobs.

When should you get rotator cuff pain checked?

Get checked if shoulder pain lasts more than a couple of weeks, disturbs your sleep, or comes with weakness. Cleveland Clinic³ advises seeing a provider for lasting shoulder pain, pain that disrupts sleep, or arm weakness. NHS guidance⁵ suggests an appointment if pain hasn't improved after two weeks.

Don't keep pushing through it. AAOS² warns that continuing to use a torn shoulder despite worsening pain may cause more damage. Mayo Clinic¹ notes that untreated rotator cuff problems can lead to lasting stiffness or weakness.

A sudden tear is worth a prompt medical exam, because timing can affect your options. AAOS² lists a recent injury among the reasons a surgeon may consider repair. A medical doctor decides whether you need imaging or a surgical opinion.

Shoulder pain isn't always the shoulder. Pain in the arm or shoulder with chest pressure, shortness of breath, a cold sweat, or nausea can mean a heart attack. Call 911 right away⁴. Read more about left shoulder pain and your heart.

What helps rotator cuff pain?

Many people improve without surgery. AAOS² reports that nonsurgical care relieves pain and improves function in about 80 to 85% of patients. Cleveland Clinic³ says about 8 in 10 people with partial tears improve without surgery, though it can take up to a year.

Nonsurgical care usually includes:

• Changing the activities that hurt. Cut back on overhead reaching and heavy lifting for a while².
• Keeping the shoulder moving. NHS guidance⁵ says not to stop using your shoulder completely, because that can slow recovery.
• Strengthening exercises. Strengthening and physical therapy are core parts of care². See rotator cuff exercises you can do at home.
• Cold or heat. NHS guidance⁵ suggests a wrapped cold pack or hot water bottle for up to 20 minutes at a time.

Where chiropractic care fits

Your chiropractor starts by listening and checking your shoulder, neck, and upper back. X-rays are taken only if your exam calls for them. If anything points to a tear that needs medical care, your doctor will tell you and help you get it.

From there, care often combines gentle joint movement, gentle muscle work, and guided strengthening. Exercise has the strongest research support for most shoulder pain. Hands-on care is usually paired with it, not used alone. You choose your care, and adjustments happen only if you want them.

Find out what's behind your shoulder pain

A sore shoulder chips away at your day. You reach for things with your other hand, skip the gym, and dread rolling over at night. You're not sure if it's a strain that will pass or something torn.

We're here to help you find out. Chiropractic Company has cared for Greater Milwaukee since 1982, with 400,000+ patients, 1,400+ five-star Google reviews, and 20+ neighborhood clinics. We look for the cause of your pain, not just the symptoms. Your care is designed around your condition, your medical history, your daily routine, and your goals. You choose your care, and you see the same doctor as it continues. We work alongside medical doctors when you need imaging or a surgical opinion.

Care is natural and drug-free. Treatment begins at your second visit, or the same day in acute cases if your doctor decides it's appropriate. Rotator cuff care leans on strengthening, so some plans add physical therapy at our Menomonee Falls, Waukesha, and West Allis North clinics. Learn more about our approach to shoulder pain.

We're in-network with most insurance companies and accept Medicare and workers' compensation. Eligible new patients can start with the $29 new-patient special, which includes a consultation, an exam, and X-rays if needed. *See offer terms.

Visit one of our 20+ neighborhood clinics across Greater Milwaukee: Milwaukee East, Milwaukee North, Milwaukee Third Ward, Shorewood, Glendale, Mequon, Cedarburg, Grafton, Germantown, Brookfield, Menomonee Falls, Waukesha, Oconomowoc, New Berlin, West Allis, West Allis North, Greenfield, Hales Corners, Franklin, Muskego, and Cudahy.

Frequently asked questions